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It is sometimes forgotten that tuberculosis is an infectious
disease, mainly spread by droplets coughed into the air, the disease
differing from the previous acute infections in that it tends to run a
more chronic course. Skin testing suggests that about 13% of
the local children have met the infection by the time they are 13
years of age. Their reaction probably depends on the doses they
receive at any one time and on their general health and individual
susceptibility. In most people the germs become sealed off in the
lungs without obvious symptoms being noted. It is not yet clear
whether the cases which are notified among older children and
young adults, if and when the disease is active and tending to
spread, are persons who have just received their first infection or
who have become reinfected, or alternatively are persons in whom
the original sealing off process has broken down, possibly due to
subnormal general health combined with adverse circumstances.
The latter is probably the cause of the increasing proportion of
notifications of persons of 45-65 years of age, and particularly of
males in the post war years.
It will be seen from the last Table that apart from the war and
immediate post war years, there has been a steady decline in the
case rate, (i.e. the proportion of the population recognised annually
as suffering from active disease whether pulmonary or nonpulmonary)
and in the corresponding death rate. While this improvement,
which is fortunately occurring throughout the Country
as a whole, is welcomed, it must be remembered that the battle
against this formidable disease still goes on, with relatively high
casualities still occurring. Treatment has become increasingly
successful, especially in those cases which are recognised early,
but sufferers are out of action for quite long periods compared with
those suffering from other infections.
Undoubtedly the improvements in nutrition, housing and
other factors affecting our standard of living, have made a major
contribution to the success in dealing with this disease. The wider
use of Mass X-ray Units in diagnosis has and does help in early
diagnosis, while still more recently, skin testing combined with
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